Neonatal Carotid Artery and Internal Jugular Vein Management Practices at Extracorporeal Membrane Oxygenation Decannulation: No Standard Approach

Allison F Linden; Amy A Howk; Zeenia Billimoria; Matthew Devine; Robert DiGeronimo; Brian Gray; Shannon E Hamrick; Sarah D Keene; Natalie Rintoul; Burhan Mahmood; Children's Hospitals Neonatal Consortium (CHNC)

doi:10.1016/j.jpedsurg.2023.07.007

Neonatal Carotid Artery and Internal Jugular Vein Management Practices at Extracorporeal Membrane Oxygenation Decannulation: No Standard Approach

J Pediatr Surg. 2023 Nov;58(11):2196-2200. doi: 10.1016/j.jpedsurg.2023.07.007. Epub 2023 Jul 24.

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA. Electronic address: Allison.Linden@choa.org.
² Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA.
³ Division of Neonatology, Department of Pediatrics, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
⁴ Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
⁵ Department of Surgery, Indiana University, 705 Riley Hospital Dr, Bloomington, IN, 46202, USA.
⁶ Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA.
⁷ UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.

PMID: 37573253
DOI: 10.1016/j.jpedsurg.2023.07.007

Abstract

Background: There are currently no commonly accepted standardized guidelines for management of cervical vessels at neonatal extracorporeal membrane oxygenation (ECMO) decannulation. This study investigates neonatal ECMO decannulation practices regarding management of the carotid artery and internal jugular vein, use of post-repair anticoagulation, and follow-up imaging.

Methods: A survey was distributed to the 37 institutions in the Children's Hospitals Neonatal Consortium. Respondents reported their standard approach to carotid artery and internal jugular vein management (ligation or repair) at ECMO decannulation by their pediatric surgery and cardiothoracic (CT) surgery teams as well as post-repair anticoagulation practices and follow-up imaging protocols.

Results: The response rate was 95%. Pediatric surgeons performed most neonatal respiratory ECMO cannulations (88%) and decannulations (85%), while all neonatal cardiac ECMO cannulations and decannulations were performed by CT surgeons. Pediatric surgeons overwhelmingly ligate both vessels (90%) while CT surgeons typically repair both vessels at decannulation (83%). Of the responding centers that repair, 28% (7) have a standard anticoagulation protocol after neck vessel repair. While 52% (13) of centers routinely image cervical vessel patency at least once post repair, most do not subsequently repeat neck vessel imaging.

Conclusions: Significant practice differences exist between pediatric and CT surgeons regarding the approach to cervical vessels at neonatal ECMO decannulation. For those centers that do repair the vessels there is little uniformity in post-repair anticoagulation or imaging protocols. There is a need to develop standardized cervical vessel management guidelines for neonatal ECMO patients and to study their impact on both short- and long-term outcomes.

Level of evidence: IV.

Keywords: Carotid artery and internal jugular vein reconstruction; ECMO decannulation; Neonatal ECMO.